Team Leader High Risk Checklist

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Temperature Checks weekly check

• Csa booklet - Hot Hold Temp Checks completed

  Yes

  No

  N/A

• Csa booklet - Equipment temp checks completed

  Yes

  No

  N/A

• Csa booklet - Delivered good temperatures completed

  Yes

  No

  N/A

• Comments of non compliance or action taken.

Vital gas weekly check.

• All Csa nightly tests completed and weekly form signed off

  Yes

  No

  N/A

• Which emergency button was tested.

• All valves fully closed when emergency button pressed

  Yes

  No

  N/A

• Time taken for valves to fully close

  3 sec

  4 sec

  5 sec

  6 sec

  7 sec

• Comments of faults or any action taken

Water paste Test completed.

• Csa who conducted the test

• Tank 1

  Select Ulp Diesel E10 Vortex 95 Vortex 98 Eflex Not in use

  • Ulp
  • Diesel
  • E10
  • Vortex 95
  • Vortex 98
  • Eflex
  • Not in use

• Water Level Recorded

  0

  +50

  +100

  +200

  +500

• Tank 2

  Select Ulp Diesel E10 Vortex 95 Vortex 98 Eflex Not in use

  • Ulp
  • Diesel
  • E10
  • Vortex 95
  • Vortex 98
  • Eflex
  • Not in use

• Water Level Recorded

  0

  +50

  +100

  +200

  +500

• Tank 3

  Select Ulp Diesel E10 Vortex 95 Vortex 98 Eflex Not in use

  • Ulp
  • Diesel
  • E10
  • Vortex 95
  • Vortex 98
  • Eflex
  • Not in use

• Water Level Recorded

  0

  +50

  +100

  +200

  +500

• Tank 4

  Select Ulp Diesel E10 Vortex 95 Vortex 98 Eflex Not in use

  • Ulp
  • Diesel
  • E10
  • Vortex 95
  • Vortex 98
  • Eflex
  • Not in use

• Water Level Recorded

  0

  +50

  +100

  +200

  +500

• Tank 5

  Select Ulp Diesel E10 Vortex 95 Vortex 98 Eflex Not in use

  • Ulp
  • Diesel
  • E10
  • Vortex 95
  • Vortex 98
  • Eflex
  • Not in use

• Water Level Recorded

  0

  +50

  +100

  +200

  +500

• Tank 6

  Select Ulp Diesel E10 Vortex 95 Vortex 98 Eflex Not in use

  • Ulp
  • Diesel
  • E10
  • Vortex 95
  • Vortex 98
  • Eflex
  • Not in use

• Water Level Recorded

  0

  +50

  +100

  +200

  +500

• Comments of faults or any action taken

• All daily E10 checks have been completed and all ok.

  Yes

  No

  N/A

• All daily E85 checks have been completed and all ok.

  Yes

  No

  N/A

Security Test 1800 225 839

• Csa who conducted the test

• Pendant buttons Tested

  1

  2

  All

• Counter buttons Tested.

  1

  2

  All

• TV Monitors Working

  Yes

  No

  N/A

• Front doors Security Locks Working

  Yes

  No

  N/A

• Comments of faults or any action taken

Sharps containers

• Sharps kit in correct location at console

  Yes

  No

  N/A

• Correct contents<br>Instruction Card<br>Tongs<br>Anti prick gloves<br>Rubber gloves<br>Sharps container<br>

  Yes

  No

  N/A

• Toilet containers available and clear for use.

  Yes

  No

  N/A

• Comments of faults or any action taken

Forecourt Spill Kit / Blue Trolley

• Spill Kit Correct contents<br>2 x Gloves<br>2 x Goggles<br>3 x sand bags<br>2 x pillows<br>2 x socks<br>Towels<br>Instruction Cards<br>Forecourt broom in good condition

  Yes

  No

  N/A

• Blue Trolley Correct contents<br>2 x Flashing lights <br>Water paste tube<br>Anti prick gloves<br>Rubber gloves<br>Pump wipes<br>Forecourt garbage bags<br>Pump degreaser<br>Safety torch<br>4 x large witches hats

  Yes

  No

  N/A

• Comments of faults or any action taken

Emergency equipment and Procedures

• Flip chart at console and numbers correct

  Yes

  No

  N/A

• Hazmat contents and locked

  Yes

  No

  N/A

• Test PA system is working

  Yes

  No

  N/A

• First aid kit has correct contents and eye wash is in date

  Yes

  No

  N/A

• All incident reports recorded on server and emailed

  Yes

  No

  N/A

Verification -

• Team Leader who conducted the audit report.

• Add signature

  Sign

• All the above information has been visually and physically checked by the Team Leader. With the signing of this audit report the Team Leader is satisfied that all standards and compliances at time of report are true and correct. Any standards and compliances that are not 100% correct must be action and comments recorded in audit in the correct comment sections. If a standard or compliance cannot be 100% achieved a email must also follow up with the submitting of this report.

• Final Comments.

  Yes

  No

  N/A